HIV & HEPATITIS C
The HIV epidemic in Vietnam is highly concentrated in most-at-risk populations (MARP), including people who inject drugs, sex workers, men who have sex with men, and the sexual partners of vulnerable groups, such as male clients of sex workers. It’s estimated that there are currently 260,000 individuals living with HIV in Vietnam, of which up to 65% are injecting drug users. According to 2009 data, 58% of people who inject drug in Vietnam are infected with Hepatitis C (HCV). Rates of co-infection of HIV and HCV among MARPs have emerged as an urgent health issue, and HCV is quickly becoming a leading cause of death among people living with HIV. PSI/Vietnam promotes HIV and HCV programs and services to empower MARPs to lead healthier lives. Highlights from each of these program areas include:
HIV & HCV Prevention Product Social Marketing: Condoms and Syringes
In addition to promoting condom use through targeted behavior change communication activities, PSI/Vietnam works to increase condom availability in high-risk areas and non-traditional outlets including guest-houses, hotels, street vendors, cafes and massage parlors. By convincing owners of non-traditional outlets and entertainment establishments to purchase and promote condoms, PSI/Vietnam’s social marketing program is promoting a sustainable approach to HIV programming in the private sector. PSI/Vietnam works closely with USAID, Vietnam Administration of HIV/AIDS Control and the provincial government to provide technical assistance, develop social marketing programs and coordinate condom distribution. PSI/Vietnam also promotes female condoms for sex workers and water-based lubricants co-packaged with male condoms for men who have sex with men and sex workers. In 2013, over 8.7 million male and female condoms were sold and circulated to over 4,200 hotels/guesthouses and other non-traditional outlets accessible to key populations in nine provinces that are a priority for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
In response to input from people who inject drugs and market surveys, PSI launched the world’s first low dead-space syringe (LDSS) social marketing pilot in 2013 to reduce supply- and demand-side barriers to using safer needles/syringes. The World Health Organization recommends LDSS distribution, given that they contain an estimated 100 times less fluid compared to high dead-space syringes, drastically reducing the risk of both HIV and HCV transmission. Increasing convenient access to quality and affordable LDSS coupled with behavior change communication promoting safe non-sharing behaviors has reduced reported needle/syringe sharing rates by half in the first year. The pilot has been extremely successful, generating over 720,000 LDSS sold and 6,000 averted DALYs in the first year.
HIV Prevention Behavior Change Communication
PSI/Vietnam’s communications support for HIV services have included the development of a national Chan Troi Moi (New Horizons) brand and multiple campaigns to promote the benefits learning HIV status among MARP individuals and couples. In 2013, the Ministry of Health endorsed the Chan Troi Moi campaign as a national campaign and facilitated placement in non-PEPFAR supported provinces, thereby dramatically increasing campaign coverage and contributions to national HIV/AIDS program goals. PSI has developed multiple campaigns to address barriers to consistent condom use, including the “Nho Toi Moi Lan” (Remember Me Every Time) campaign designed to address the misperception that familiar or healthy-looking partners have low risk of HIV transmission; as well as the “Yes! Condom” campaign designed to reposition condoms as a sign of a modern, positive lifestyle (vs. a health product.)
PSI also implemented the only targeted outreach initiative focusing on reaching female injecting drug users who also work as commercial sex workers. The Song Dep program pioneered the use of the Unique Identifier Code (UIC) monitoring system to track outreach coverage as well as related results including % of individuals reached who were also referred for HIV services.
Over 90% of Vietnam’s rural population is not serviced by piped water supply systems, and the consumption of contaminated river water contributes to nearly 7 million cases of diarrhea annually. Limited sanitation services, unsafe water and poor hygiene practices are leading causes of pneumonia and diarrhea, which account for nearly one-third of deaths among children under five-years-old in Vietnam. Since 2005, PSI has distributed and promoted SafeWat, a locally-manufactured household water treatment product originally developed by the CDC and World Health Organization (WHO) in 1990, and licensed by the MOH/VIHEMA in Vietnam. One bottle of SafeWat provides quality drinking water to a family of six people for an entire month. In 2013 over 62,000 bottles of SafeWat were sold, protecting over 5,200 rural families.
Since 2011, PSI has partnered with Unilever and Lifebuoy soap to promote handwashing with soap – and household water treatment – in 2 rural provinces using an integrated approach through multiple communication channels accessible to rural families, including commune loudspeaker campaigns, illustrated leaflets, outdoor billboards near rural markets and community events. Interactive community events are designed to build household level commitment to treat water correctly and consistently, and to wash hands at critical junctures. In 2013 alone, PSI and Unilever organized 26 events in rural districts where families have limited access to piped water, reaching an estimated 7,000 rural caretakers and young children. In 2014 this partnership will benefit 160,000 rural caregivers in Hau Giang and Vinh Long provinces.
About one in three children under five years of age in Vietnam is stunted, whose undernutrition and micronutrient deficiency impairs intellectual development and increases the risk of morbidity and mortality. In this context, PSI/Vietnam in collaboration with the National Institute of Nutrition (NIN), the Global Alliance for Improved Nutrition (GAIN), and the Intitut de Recherche pour le Developpement (IRD) implemented a pilot project with support from Irish Aid. Over the pilot period, the project used commercial distribution channels combined with evidence-based behavior change communications (BCC) to motivate lactating/pregnant women and children under five to practice healthier nutrition behaviors, including correct and consistent use of Lyzivita micro-nutrient powder. Over 84,000 Lyzivita sachets were sold to commercial outlets accessible to rural caregivers of children under five during the first 9 months of the pilot. Additionally, 886 commercial outlets were motivated to stock Lyzivita and display BCC materials designed to promote improved complementary feeding, including 686 rural pharmacies, 148 rural fast-moving consumer goods outlets and 52 rural private clinics. Nearly 7,000 caregivers were reached through market and community-based events in 2013.
TB & HYPERTENSION
PSI applies global best practices to motivate private clinics to provide quality, affordable services designed to address key national health priorities including child health, tuberculosis and hypertension. Launched in 2012, the Good Health, Great Life social franchise network represents smaller, community-level private clinics accessible to low-income, uninsured and marginalized communities in five provinces. In 2013, franchise clinics detected more than 1,000 TB cases and treated more than 6,000 hypertension cases. Their efforts also represent a 40% increase in private provider capacity to deliver preventative child health services, including appropriate use of Lyzivita micronutrient powder to prevent under nutrition among rural children.